April 2004 Archives

With 5 hours of sleep Friday night I wasn't tired when I got home so I headed out to do some errands. They never seem to end. I found out that I clearly have been bringing my shirts to the cleaners for too long. I pulled up in front of the cleaners and by the time I was inside they had already filled out the ticket with my usual heavy starch and creased sleeves. All they needed was a count. When I was talking with them I found out that they clean a huge amount of uniforms every week, almost 10 percent of their business, and for the most part they remember how everybody gets their shirts done and even if someone else delivers the shirts for cleaning they remember. I have to say that I was impressed, looking at the number of uniforms on the tracks I could see that it was quite a large number representing easily 30 different agencies. Some people I know talk about how great it is to have a waiter or a bartender remember your preferences. I'll take a dry cleaner any day of the week. These guys keep me looking good, I can't get that from a bartender.

The rest of the day was uneventful with just a lot of running from one place to another. I did take a midafternoon break to walk through a new park in a nearby town. Very pleasant walking down by the river and I can see a lot of potential in the area. When I first started working in the county this area was an old stone quarry that had been abandon decades before. It had accumulated lots of trash and abandon vehicles and if anyone had asked me then I would have said that this area would never be clean enough to use again. I'm glad I was wrong.

The quarry itself is impressive, or at least impressive for a New England boy. I know some of the quarries and mines in the midwest and south are much more impressive. What I find so amazing is to look at the depth of the quarry and thinking about how much stone had been cut out to make such a deep and wide place. Especially amazing when I think that much of the quarrying had been done by hand or with very primative power tools. Incredible the things that were done years ago without the benefit of modern tools.

It also amazed me when I read that the hill that the trails were made on and around were on a slag pile of pieces of stone that had been cut from the quarry but were not of the right size, shape, or quality. The "hill" ends up being 70 feet high and 2000 feet long. That is a lot of rock.

Back home I finished my errands for the day out with a call to the Masters Degree program that I have applied for which resulted with me speaking with the director of the program (by accident) but resulted in much more direct answers to my questions and having her leave me her email address and direct office number if I had any problems with the admissions process. Very cool!

The other telephone call I received was a call confirming that my CV had been received for the administrative job I had been considering me and letting me know that the interview process had would begin in a couple of weeks. I'll need to bring some additional information with me at that time but the doctor that I spoke with sounded very positive and that left me feeling reasonably confident.

After my kids got back from school it was back out to run everyone around to their activities until 2000 and now, finally, everyone is in bed and if not sleeping, at least staying in their beds. I'm bushed and as much as I would like to stay up so I can sleep all day tomorrow I know that I will be crashing early.

What a night. I can't believe the night I just had. I am amazed that the night went my way. Nothing, no dispatches, no telephone calls, no pages, not so much as a peep from any other quarter. For a change I got 5 solid hours of sleep and got paid OT plus night differential for it!

Just to put some icing on the cake, the medic I relieved let me know that he killed the stupid mini-van that we had been assigned as a response unit. Not just killed it, drove a stake through it's heart. It will not be coming back and a replacement will have to be obtained. I wish I could say that I would mourn, but I won't.

Total calls for the night: 0

Milage for the night: 0

CD for the night: whatever the soundtrack was to my dream while fast asleep on the sofa.

A fairly quiet night all the way around. Nobody was particularly busy. The only ALS call I did was a 62 year old man who was 2 years post CVA and having focal seizures. During the course of our transport his blood pressure went form being slightly elevated, as I would expect post seizure, to levels that I was starting to find disturbing. By the time we hit the ED in the next county he needed interventions that I wasn't able to provide. I was concerned that he was going to stroke again.

Biggest problem I have with this call isn't my treatment or even my lack of effective interventions. The biggest problem is that now, since the new privacy laws, I have no vehicle to find out what happens to him and have no idea on what could have been done or should have been done and what the outcome was.

Now that my official shift is over I am hanging around for another hour before my continuing education sessions. The first segment will be an inservice on our new portable radios, and the final segment will be our validations for the Selective Spinal Immobilization protocol.

The whole thing should be done around 1100 and then I will be able to go home and finally get some sleep.

Total calls for the night: 3
2 BLS downgrades
1 ALS transport

Total milage for the night: 77

CD for the night: "The Girl in the Other Room" by Diana Krall (well worth the wait!)

When I got home this morning I helped my wife spread about 3 cubic yards of mulch in her gardens instead of going right to sleep. For that hour of the morning it was nice mindless labour which was about all I was going to be good for.

I finally finished everything that I needed to do and headed to bed a little before noon. It's not going to be enough sleep but it will have to do. I don't have much work related stuff to get done tonight so I am hoping for a fairly busy night to keep me going and then for my mandatory CME in the morning to be unbeleivably short. I'm pretty sure that I will be exhausted my the time.

All I can say is that it is a good thing I looked at the schedule before I left for work. I could swear that I was supposed to work Medic 1 tonight but the schedule said otherwise. It would be pretty embarassing to show up at the wrong station, especially since it would be 25 miles north of where I am supposed to be.

You could call it a clean sweep. There were no calls last night which was nice. I had the opportunity to get more work done. On the other hand what I did not get to do was sleep much. The crew was very busy last night watching TV and it was just distracting enough to keep me from sleeping. Oh well, I needed to sleep today anyway.

I finished my grad school application and ready to send it out along with the transcript requests. I'll be calling this morning to talk to someone in admissions to try and get some answers to my remaining questions regarding the required statistics course, the recommendations they require, and avoiding the GRE. I am hoping that everything falls into place so I can start this summer. Even if it doesn't and I either need to take statistics again or I have to wait until the fall I am getting pretty excited about the prospect of being back in school.

I did some looking online last night and found a couple of statistics classes being offered this summer if I need the course. I felt like I should have this ready, just in case.

Total calls for the night: 0

Total milage for the night: 1

No CD for the night but the new Diana Krall CD "The Girl in the Other Room" ships today!

The rain stopped while I was sleeping this morning and I woke up to a pretty nice day. I opened the windows and set about getting some of my work done. Last month was eBay, this month is used books on Amazon.com. Last week I listed over 100 books and so far I have sold about 12. I will clear out all the "stuff" that I have in my office and attic if it kills me.

I'm going in a little early tonight so the day medic can get to bagpipe practice on time. I have to say that with few exceptions I have not cared for bagpipes. Until a couple of years ago I had never heard bagpipes except a funerals. Obviously not joyous occasions.

My graduate school application is almost done and ready to submit. I'm still trying to line up recommendations. I'm finding this hard not because I don't know who to ask but more because I am not sure what the university wants. It's been quite a while since I've been in school so I don't have a lot of academic references. Even if I could go back the 2 professors I would want recommendations from have both died since I graduated which would make that difficult. I will probably call the admissions office and see if thery can clarify. I want to have all my "i"'s dotted and "t"'s crossed.

With luck tonight will be quiet and I can get the work done that I need to get done for it to be finished.

Rain, rain, go away. Well, it would be nice if it worked. The night was very rainy but not particularly interesting. The ED was steady but under control and Medic 2 was the busy spot for the night even though he only did three calls.

I had a single dispatch all night. It would have been a call that I turfed to the ALS ambulance if things had been going well when I got there. Sometimes you just pull up on scene and find that somebody has kicked open a hornets nest. When I arrived the fire department and the ALS ambulance were already on scene. A male in his seventies had experienced chest pain while at rest and it too more nitro than usual to resolve his chest pain. I passed one of the members of the ambulance crew coming out the door of the house but got no information on the nature of the call.

I recognized that patient from my early days working in our department. He was the retired chief of the fire district I had responded into. I had transported him before and knew he had an extensive cardiac history. He seemed to be in no distress and denied any current complaints. Even so, someone (some of the firefighters were off duty paramedics) was looking at the monitor and talking about complete heart block, setting up 2 IV's and getting the pacemaker ready. I ran a 12 lead and hard as I tried I just was not seeing the same thing they were seeing. I was seeing lots of PVC's (premature contractions from the ventricles of the heart) but no blocks and nothing that looked worth being this excited about.

Since the scene was still total chaos and the treatment plan presented from the ALS ambulance was less than ideal I committed and notified the incident commander and my dispatcher that I would be going. During the transport I found out what had gotten everybody so stoked up. When the monitor had been put on it was only showing a heart rate in the 20's and it was assumed that there was a heart block. I looked at the original strips and have to say that if you looked quick it would seem pretty ugly. However, when we increased the size of the tracing it became quite clear that the patient was in a sinus rhythm with frequent premature contractions. For some people this can be their baseline rhythm. The patients vital signs were excellent, he was in no distress, and looked really good.

So I changed the plan, rather than 2 lines, pacing, and medications he got a KVO line, prehospital bloods, and 324mg of Aspirin. A nonemergent transport to the ED and he arrived unchanged, still pain free and looking like a rose. He did get admitted for observation overnight but remained stable for his entire EDcourse.

I was pretty frustrated after this call. It seems that one of the earliest things I learned as a paramedic was either forgotten or never taught. "Treat the patient, not the monitor". Sure, the monitor looked ugly when the amplitude was turned down but the patient's condition didn't match what the monitor was showing. It's such a fundamental thing.

To me this points out a deficiency in the way paramedics are trained and educated. We spend a lot of time teaching paramedic students how to interpret cardiac rhythms on the monitor and on paper and we spend a lot of time teaching paramedics algorithms on how to treat those rhythms but we seem to be failing to make the connection between the patients actual presentation and what the machine says. It's not just cardiac monitors either, pulse oximetry, glucometers, capnography, whatever. Numbers, theory, we learn it all but we don't get enough training on how to match the information we get from our machines to the way the patient looks and feels. As paramedics we have come so far over the past 20-30 years but we still have a long way to go in some very fundamental areas.

That was the only call of the night and it made it a difficult night just because by 0400 it was hard to stay in top form. I did manage to get a lot of projects that I had been sitting on finished and some reading done. One change that came up during the night was that my assignment for tonight has changed. I'll be working Medic 6 instead of Medic 2. One of the other medics wanted to swap locations so he could get some work done and, well, I owe him enough favours that even if I wanted to I couldn't say no. Besides, he always goes out of his way to help me when I need it so I'll do the same.

Total calls for the night: 1 ALS transport

Total milage for the night: 56 miles

CD for the night: "All for You" by Diana Krall

It begins. My long stretch starts tonight and while I am excited about the overtime and the new gutters and windows it will help buy I am a little sad about how much time I will be spending away from my family.

I was up late last night and sometime after I went to bed at 0300 and I got up at 0600 it started to pour. What is it about kids and raincoats that they don't want to wear them when it rains?

I'm hoping that the rain will stop tonight and tomorrow will be a nice day. I have lots that needs to get done tonight and tomorrow but much of it depends on the weather being nice.

This is going to be a rough week. Out of the next 7 days I will be working 6 of them and the one I don't will be the day my wife spends on call. I'm not always sure why I do that but the overtime will help when it comes to paying for some of the stuff that needs to be done around the house.

Tonight is going to be taken up with more work on my graduate school application and some laundry. I really want to get the application done so I can figure out when I can start and what I can take. As far as I can tell I stand a good chance of having to take my statistics course again since my credits are 14 years old. If that is the case I want to find an online statistics course that I can complete during the first part of the summer and start the actual coursework for my degree.

I was talking with one of my colleagues and he was telling me about an interesting concept being tried by American Medical Response in Florida. They call it "Power Cars" and I find it a very interesting concept.

As long as I have been in EMS it has always be a struggle to get people to (willingly) do the routine transports. Ideas like this may help solve that problem.

As I understand it, a crew is scheduled for a 10 hour shift with the understanding that their primary responsibility will be to do routine transports. The crew will work for the assigned 10 hours OR until they have completed 10 transfers. The vital piece of information here is that the crew gets paid for the 10 hours they are scheduled even if they are done with their 10 transfers in 6 hours without the threat or possibility of being held over or ordered in for additional hours. I see the motivation as being incredible to take a shift like that since not only would people want to do the transfers but they would be much more likely not to "dog it" and stretch them out any longer than they have to.

I don't know about anybody else, but if I were offered a deal like that a couple of days a week I would have grabbed it and ran. I remember some shifts when I worked for a commercial service where 10 transfers only took me a few hours. The idea of being free and clear to go home is very appealing. This tells me that somewhere there is a manager that is actually thinking outside the box.

Surprisingly enough my daughters campout wasn't as bad as it could have been. Her Girl Scout leaders said that she was one of the two girls in the troop that actually slept through the night. She was happy in the morning and not nearly as hyper and perseverative as she usually would be in a strange place. When I got there she was happy, reasonably controlled and even though her interaction with the other children was minimal it gave me some hope that she would be able to do acceptably, even if not well, in social situations with her peers. That was quite a relief.

Now were are off to see my in-laws for one of the last visits to their home near New York before they move to Cape Cod full time. I know that my wife has very mixed feelings about it since the move means that they are selling the home that she grew up in. Even so the thought of having a place near the sea is very appealing to both of us. It's not a lighthouse but since it's close to several I guess it will do.

We'll be coming home again tonight so that I can be on Daddy Duty for the day tomorrow while my wife is on call. On a good day she would go in and make rounds and then be home for the day. On a bad day she'll go in at 0800 and be there until Monday morning. I don't like those days but I am able to deal it better than my kids usually do. That, however, is a worry for the morning, not now.

It wasn't exactly a bad night. Only one call which was more of a problem solving mission than a medical emergency. I never like going to bars for calls because they are never what they start out being, as if that surprises anyone. It always amazes me how complex people can make situations without even thinking about it. All it took to diffuse this situation was to give everyone an acceptable way out and still able to stay reasonably dignified.

What it wasn't was quick, it took almost an hour to finally get everyone where they needed to be and everybody reasonably happy. After it was taken care of and all parties involved were satisfied we went back to quarters and did other things. I say it that way because the crew spent a good part of the night watching movies and I spent a good part of the night trying to sleep. I don't know if I just got tired enough to ignore the movie or they got tired enough to turn it off but finally around 0300 I was able to fall asleep.

Three and a half hours later I was waking up and feeling pretty good. My relief will be here any minute and then I will have to go and get my daughter from her camp out and see just how good or bad it was.

I slept later than I had planned this afternoon but hopefully I will be able to get some sleep anyway. On the other hand it's been over 24 hours since Medic 6 did its last call and have to think that we're due.

I'm hoping that I'll get out on time in the morning too. My oldest daughter is on her first overnight campout with the Girl Scouts and I am praying that it will be a success but I am very afraid that with her Aspergers Syndrome and anxiety it will be a total disaster. As soon as I am out I will be heading over to there. She has never done anything like this before and I am just not sure how she will react to a different situation.

As soon as I got in I was out on the road. The medic that had held over for me was still out. All the early calls we not much of anything but around 0200 or so I was dispatched as the second medic in on a reported 3 car crash with 2 vehicles over an embankment in Medic 3's territory.

I arrived on scene about the same time as the second ambulance and Medic 3 directed me to a male patient who had been driving a pickup truck that rear ended another vehicle at high speed. He had self extricated himself fro his truck and had been attempting to walk when the police arrived. Problem was that his right thigh had a very unnatural angle in it and he was unable to bear any weight on it. One look at the inside of the truck and there was no doubt in my mind that he had been unrestrained. The steering wheel had been bent on all sides, the steering column was bent and there was a large dent in the dashboard where his legs would have been.

With the amount of damage I was seeing I was still surprised what good shape he was in. All I could find on him was the obviously broken femur and a number of abrasions across his chest and torso. Oh, and the fact that his heart rate was well over 150. Not only was it clear that he had some significant injuries, and that he was quite drunk, but it was rapidly becoming apparent that he was also quite obnoxious.

We loaded him pretty quickly and started transporting to the trauma center about 30 minutes away (it would have taken less time if it were not raining). 2 large bore IV's, traction splint, high flow oxygen and I started titrating Morphine administration for his pain. His pain started out as a 15 on a scale of 0 to 10 and by the time we had arrived at the trauma center he had received 10 milligrams and it was down to 11 out of 10. Clearly these numeric pain scales don't work well with young people who have very little to compare their pain to.

He got the whole trauma work up and screamed quite lustily as the drew his blood, put the catheter into his bladder, and a tube down his nose into his stomach to check for blood. In the end his work up was all negative except for a badly fractured femur. It took a while to finally clear the hospital and head back to where my vehicle had been abandon on the side of the road.

The one weird thing? A few minutes after I start enroute to the trauma center I hear Medic 3 clearing the scene, the other patient would be transported BLS. Heh, his district, his call, and I'm the one who ends up transporting the only ALS patient. Oh well.

I was back in service by 0430 and spent the rest of the morning clearing paperwork from the shift. I was pretty tired by 0700 and very happy to see my relief coming through the door.

I'll sleep some of the day but I don't want to spend too much time asleep. I'm due back in for OT at Medic 6 2300-0700 and I hope to get some sleep there.

Total calls for the night: 7
1 ALS transport
2 ALS turned over to the ALS ambulance
2 Cancelled upon arrival
2 Cover assignments

Total milage for the night: 72 miles

CD for the night: "Night Train" by Oscar Peterson

Not a very busy night, but one with a theme. Both patients I saw were GI bleeders, one who was in critical condition and one who was not, yet.

I knew I was in trouble on the first one because the nurse at the SNF met us at the door. Usually at this particular SNF you have to practically call out the dogs just to find someone to give you report. As soon as the door opened I could tell what the problem was, the smell was unmistakable.

In EMS there are really three smells that you can never forget even if you wanted to. The smell of bodies that have been dead for a while, burned flesh, and GI bleeding.

When we got into the room the patient was pale, diaphoretic, cold to the touch. His heart rate was over 120 and his blood pressure was nonexistent. There was clearly no use staying inside to evaluate him any further and we essentially scooped and ran. We were 20 minutes from the hospital at best. One of the satellite ED's was closer but I knew that they had only a single unit of blood and no capabilities to actually stop the bleeding. This patient needed to be somewhere with blood and a surgeon. I would have loved to get a couple of large bore IV's in place while we were enroute but I was lucky to get two IV's in period. By the time we hit the ED the patient did have a blood pressure but just barely. When I left they were getting ready to intubate him. I don't have a good feeling about his chances to survive.

As I rode back in the back of the ambulance I thought about why I was feeling badly about this and after a while I realized that biggest problem wasn't with my care but rather the treatment his wife was receiving from the SNF staff. This situation was a little different. This man and his wife were both patients at the same SNF and shared a room. I didn't realize this until we had arrived at the hospital. While we were in the room the staff kept going behind the curtain and telling the other patient to "be quiet" and "shut up" while we were evaluating and preparing for transport. Not that I realized that this other patient was his wife I was pretty sickened by the treatment that she received. It was entirely likely that my patient may die from his bleed and his wife was denied the chance to see or speak to her husband for what may end up being the last time.

When I arrived back at the SNF to retrieve my truck I really wanted to go back inside and speak with the wife and tell her what was happening. I felt like she deserved to know what was going on. I wanted to, but I didn't. Another call had come in and they were looking for me to respond. By the time I was available again it was much too early in the morning. I could only hope that the staff actually talked to her after we left. By the time the shift ended I felt pretty lousy about the whole situation.

Total calls for the night: 4
2 ALS transports
1 BLS downgrade
1 Cover assignment

Total milage for the night: 57

CD for the night: "The Best of Thelonius Monk" by Thelonius Monk.

Another nice day when I woke up. Gentle breeze blowing in the window, just a hint of a chill in the air. I started working on my applications for grad school last night and while it is slow going I am pretty happy with the way they are progressing.

I won't be able to work on them tonight at all since I will be getting ready for the class I have to teach Thursday night. As usual, I have lots of minor tweaking I want to do to the presentation and lots of copying I need to do for handouts, exams, and such. So I have a lot of work to do as Medic 2 in addition to whatever calls come my way.

A few years ago I had a medical student come and ride to see what medicine in the streets was like. During the several days he spent with me we talked about a lot of things but talked a lot about the effects of the job on peoples well being and what kind of people are attracted to EMS.

He has since graduated from med school, done a residency in psychiatry, and has moved on to a fellowship in psychiatrity. I happened to notice a research proposal of his tonight.

He wants to do a multipart multicenter study looking at a number of things like the prevelance of ADD and ADHD symptoms in EMS workers, the incidence of depression and other mental illnesses in EMTs and Paramedics, how best to screen applicants and workers for signs and symptoms of mental illness and improve compliance with mental health treatment among EMS workers. There were other objectives but they were in such serious psychiatric language that I couldn't follow them all.

Heh, that should be an interesting study and I would be really interested in reading the results. I wonder if it would be a first step in changing how EMSviews mental illness, I mean, looking at it from the inside sure gives you a different perspective.

Usually when I say I'm doing my part for the economy I am referring to the fact that I have been buying things. Today I am back on the selling side. More spring cleaning today in my office among other places. I have cleaned out some electronics and lots of books and all are going to be listed either as used books on Amazon.com or out to eBay sometime in the next couple of days. I'm not sure some of this stuff will sell as usable computer equipment but some of it will surely go as antiques and oddities.

Oddities, thats a funny way to describe the triple bay CD tower I built out of spare parts when I needed to have multiple CD's mounted at the same time. It's pretty old and I'm not sure who wants it but you never know. Right after I listed that on eBay I listed my old Fortran and Pascal textbooks on Amazon.com. I sold the Fortran book already much to my surprise.

I have always enjoyed trying to make my computer submit to my will and actually do what I want it to do and computer programming was a natural step. I am not very good at it even after all these years but I still work at it as time permits. Someday I hope to have the time to get serious and finish the projects that I have outlined and waiting to be worked on.

I slept with the windows open last night. Yes, it was a bit chilly by morning but it was so great to go to sleep and to wake up to a gentle breeze blowing through the room. I love open windows when the weather is nice.

I'll have to pay for yesterdays decadence by doing a lot of the work that I shirked today. It doesn't matter, it was so good to just get out for a while.

I got home this morning and after some work around the house lay down to get some sleep. Funny thing, I wasn't really tired, and I really didn't feel like working anymore either. What I really felt like doing was being outside, pushing myself a little bit, working up a good sweat, and trying to do something healthy.

Geocaching is a good excuse for me to get outside and do something recreational and physically active yet geeky at the same time. I looked up a few caches nearby specifically looking for ones that were more difficult or had harder terrain and selected three. I wasn't sure of I would get to all of them but I figured having too many was better than not enough.

I'll say this right up front, seeing an overweight, almost middle-aged, bald guy leaving home in shorts, a tee-shirt, and hiking boots could not have been a very attractive sight. It was in the low seventies already, sunny, with a nice breeze. I was feeling pretty good, spring was here, the sun was out, I really felt like I had made it over my "end of winter hump" to emerge back out into better moods. During the winter if someone had commented on how I was dressed they might have gotten an unpleasant request back to them, today, I would have just ignored them altogether. For the first time in months I was really feeling good.

The first cache was in a state park on the other side of the river from my house and a few miles downstream. I parked at the ferry landing and pulled out the trail map and did my best to reconcile it with the GPS coordinates I had. I started out on the trail I thought I should be on and almost immediately it started going up in a series of switchbacks to the top of a ridge a couple of hundred feet higher than where I parked. By the time I hit the top I had worked up a good sweat but was enjoying the sunshine and the nice breeze. I followed the trail map to where I thought I needed to be, took a trail that branched off of the main trail (not on the map either) and followed it until the GPS said I was within 60 feet. That was good, I figured I would make short work of this one and finish very quickly..

Whoever hid this one was very clever. I had to stop short when the trail abruptly ended with 30 feet still to go according to my GPS. OK, clearly I had neglected to look at this problem well enough. I am supposed to be 30 feet from my destination but I have run out of trail. I could look at the slope and see what handholds and footholds were there but alone, without proper equipment and training I thought that would be less than an ideal solution (who am I kidding, it would have been plain stupid). Clearly I was not in the right place.

Back out to the main trail I found a log to sit down on and pulled out the trail map again and looked to see if I had misread something. No, I didn't think so, I felt pretty confident in my ability to read a map and use my GPS. Still, I had pretty obviously missed something crucial. I started back up to the crest of the ridge and as I stood at the top it struck me, it was so simple I couldn't believe that I had missed it. I spend so much time telling students and paramedic candidates to think outside the box and to not to ignore the unorthodox ideas that may solve a problem. I had to look hard at the map not to see what was printed on it but to realize that I had been viewing my world in two dimensions, I had the x and y axes down fine but forgot the z axis. The answer was so absurdly obvious that I was almost ashamed that I didn't think of it before.

I trotted back down to the riverbank and started looking for the solution. The trail map showed no trails in this area so I threw it out. Clearly I had to look for trails that were not 3 feet wide, smooth, well marked and well tended. When I found an overgrown track that followed the riverbank north I knew I was in the right direction. The GPS and what must have been a well used trail some years ago brought me to a spot at the bottom of the drop off I had run into before. I was about 80 feet below where I stopped on the higher trail. It took me about 20 more minutes to finally decide to climb the rocks to a ledge that was about 15 feet above me just on a hunch. It was a good hunch, wrong, but still good. As I picked my way back down I came right on the cache hidden in a cleft of in the rock face about 10 feet above the trail and, when I looked closer, easily reached from below by standing on a small boulder.

I felt elated to have found this. As caches go it was certainly not the most difficult ever placed but it was certainly the most difficult I had ever searched for one that I knew had eluded many people before.

During the whole process I had worked up a sweat that felt wonderful and as I sat on the ledge looking out over the river drinking my water I relaxed and just enjoyed the view, the breeze, and the solitude. I stayed for about half an hour just sitting there with my thoughts contemplating some of the questions that I have in my life right now. Without the distractions of day to day life some of the answers came to me and other started to coalesce into ideas that made me think. I certainly have to remember this spot, comfortable, solitary, and so close yet so far from my day to day life that I can regain some perspective.

I took in both of the other caches during the afternoon, one pretty straightforward and the other requiring some serious bushwhacking and traversing some pretty wet, moss covered rocks to get to the top of the hill where the cache had been hidden. I spent the time solidifying my thoughts and ideas from earlier and by the end of the afternoon was dead tired, rubber legged, dirty, sweaty, and downright jovial. Decisions had been made and I was feeling very upbeat. What had I decided? Stay tuned, I'll put the balls in motion over the next couple of weeks and see what happens. All I can say now is that the friend who reminded me so many months ago that allowing the mind to grow and expand was a good thing. The envelope is officially being pushed.

What am I listening to? The Rovin' Dies Hard from the album: Etched in Stone by Off Kilter

The trend did not continue but I won't complain anyway. Shortly after I arrived I went out to get some dinner and we were sent for a swollen foot post ankle fracture. Impressively large but not ALS by any means.

Another call came in a couple hours later for an unresponsive person and I worked this patient up and transported her to the hospital. She had a fever and sounded very "junky". It amazes me that the SNF could not only leave her that way but document that she had been unresponsive three hours before they called. I'm sure the 4 litres of oxygen by mask didn't help either since I think she was ending up with less oxygen delivered to her than is in room air. Hypoxia come in. This kind of stuff used to really yank my chain but maybe I'm gettign cynical or jaded in my old age but I just document what I found to the appropriate people and try not to think about it too hard.

While we were gone with this patient there were two other EMS calls at the same time which, luckily, I wasn't needed for and the BLS backup ambulances handled themselves.

Once they got back things quieted down quite nicely and everybody fell asleep. Surprisingly even I fell asleep and slept pretty well for almost 5 hours. A nice change.

Total calls for the night: 2
1 BLS downgrade
1 ALS transport

Milage for the night: 22

No CD for the night.

I am hoping that since I have been up all day I will be able to sleep at Medic 6 tonight. Usually I find myself not sleeping or sleeping badly but tonight I am fairly tired.

The day medic spent 12 hours doing nothing and I hope to continue the trend. I want to log the geocache we found this afternoon and then just relax.

After spending a fair amount of the day yesterday asleep I crashed pretty early last night, as soon as we got back from the Bar Mitzah dinner we were at and I slept until almost 0900 this morning. We had put the screens into our windows yesterday so I awoke to some nice, gentle breezes coming through my window. The breeze alone made me not want to move. It's been a long winter and I have been enjoying the warmer weather and fresh air.

My wife and I did some more work around the house while the kids played outside and we felt like we got a fair amount accomplished before we left to go have a late lunch/early dinner with my parents.

We had some conversations during the morning and afternoon about my future and my need to go ahead and start work on a Masters Degree. I had found a couple of Masters programs that were based online and would give me the background that I needed for whatever I was going to do in EMS in the future. It will take a few years no matter where I go and I may need to retake some of my undergrad credits since it has been 16 years since I had statistics. My other worry is the GRE (Graduate Readiness Exam), sort of SAT's for admissions into grad schools. I am too old and been out of school for too long to be dealing with this kind of hassle. This has made one of the programs I was looking at much more appealing since they will waive the GRE if I were to successfully complete three grad level courses there. I am hoping that I can get all the paperwork done in order to start for the beginning of the summer. The sooner I start the sooner I get done.

On the way back from meeting my parents we stopped to take in a geocache on the way home. It was a delightful walk on an old estate. The kids had a wonderful time and were really the leaders with the older two reading the GPS unit and deciding which way to go. It was our first multi-stage cache and we found teh first stage quite easily but had to work for the final stage. For me, it was still a nice and relaxing walk.

Whoo whee did we get hammered on for the beginning of the shift. Medic 2 was taken off line for a while and that left just the two of us to cover the county. I didn't even get a chance to get my bottle of Diet Coke after punching in before the calls started to roll in. For about 5 hours we ran from one call to another both in our areas and covering Medic 2's area. Medic 3 ended up transporting totally on the other end of our service area and transporting to a major hospital on the shoreline, putting him almost 90 minutes from his base. Fortunately the EMS Education Coordinator came on line as Medic 7 a few hours into the shift and we were back to full strength for the remainder of the night.

I started with a 46 year old male with chest pain and a syncopal episode lasting three minutes on to the abdominal pain at a local detox facility to the OD that arrested as we finally were able to get him down the stairs to a seizure deep in Medic 2's area and finishing the early part of the shift with an insulin dependent diabetic who mistook his regular insulin for Lantus and had a glucose of 9 and a cover assignment. All this before midnight.

After midnight it slowed down and I was able to catch up on the paperwork and handled just two cancelled calls during the rest of the shift.

You know, there is nothing better than a busy shift with good calls and significant interventions.

Total calls for the night: 8

Total milage for the night: 144

CD for the night" "Live in Paris" by Diana Krall

Kind of a strange day, I ended up home with my middle daughter who woke up with a sore throat and fever. That threw a real wrench into my sleep schedule but when I add up all the short periods of sleep that I got I slept enough.

The pager has been going off like mad trying to fill a sick call for Medic 2 tonight. As it looks now Medic 2 will be offline until 0100 which will make things busier and more difficult. 550 square miles with 2 units is not the ideal situation.

On the brighter side I did manage to get tickets to one of the local concert venues for Diana Kralls appearance in June. I was very surprised that the concert was almost sold out by midafternoon. I am looking forward to the concert and, before that, the arrival of my copy of her new album "The Girl in the Other Room".

A fair night, three calls and only one of them was a disaster. It wasn't a very complex call just one where I wasn't able to do anything. Try as I might there was just no way I could get a line in this patient and as a result treating her hypotension and dyspnea was not easy. Treat the low blood pressure by laying her flat and her breathing got worse, sit her up and her breathing got better but her blood pressure plummeted. Her 12-lead ECG was pretty unremarkable but when the ED staff finally got IV access on her the labs showed that she was having a pretty significant heart attack. Just one of those calls that don't give you the warm and fuzzies at the end. I didn't do anything to harm the patient but I really wasn't much of a help either. Frustrating.

This afternoon I was thinking about what I had written about the fire service and law enforcement doing EMS first response. I reread what I had written and what I realized was that I made it sound so easy. The fact of the matter is that even though my system has excellent relationships between the paramedics, transport ambulances, and first responders it is something that we have worked hard for and cultivated since the before the first paramedic unit hit the streets.

*Soapbox mode on*

As with any major changes in situation there is tremendous FUD (fear, uncertainty, doubt) and a certain amount of distrust between all the agencies involved. What needs to happen is that the roles need to be clearly defined and the interactions must be, not scripted or choreographed, but carefully developed until all parties are used to working as a team.

Certainly the law enforcement and fire service first responders I see on a regular basis are not all excited to be doing EMS but most have realized that over time it has become an important part of the mission of their department and as such they have no real choice as to whether they are going to do it or not. That being said what they do know is that their roles are clearly defined both by their superiors and by the paramedics. We've worked hard to get to this point and have acheived much in that regard. We have come to recognize those responders who are comfortable and confident with their skills and give them lattitude to do what they are trained to do. We work to supplement them, not replace them.

I have no say in whether fire or police respond to medical calls but what I can do is keep things working as smoothly as possible, encourage them to do what they are capable of doing, teaching those who want to learn more, and not alientating those who are there only because the "white hat" told them they would be there. In reality it shouldn't matter, with a little effort on all sides it can be made to work and work so that the patient recevies the biggest benefit. Oh yeah, anybody remember the patient? The whole reason we are out here?

The reality for me has been that even those that don't want to be there will soften and become at least willing participants if they are treated as respected professionals and a valued member of the team.

*Soapbox mode off*

I'll be Medic 2 tonight so I will not have the opportunity to work with any of the career fire departments in our service area but I will work with a couple of municipal police departments and a dozen of so volunteer fire departments and ambulances as well as the state police. Because of the effort put out by the exceptional paramedics I work here with both presently and in the past working well with such a variety of agencies will not be the major challenge.

I have always wondered what the purpose of homeownership was and long ago came to the conclusion that the purpose is to seperate you from your money. Our house did not disappoint us this morning. The "Septic Tank Guy", I don't know what his official title is, came this morning to do what he does and in the process of filling his tank with, well, you know, found that we had more problems. Sure, why not? Yeah, the tank is cracked and the leaching field needs to be replaced. Last year it was all my major appliances and I hope this is not a sign of what is to come.

Sometimes I think I would be better off just to get a second full time job. One to pay off our debt and the other to pay for whatever the house is throwing at us next.

The shift looked like it would be a busy one at the beggining but after midnight things got very very quiet. I wasn't going to complain, it was raining and while I am no fan of working in the rain it was the dense fog that made me want to stay in. On one call I drove down along the beaches and even though I was very close to the water I couldn't see it from the roadway, no more than 40 or 50 feet. Even the lighthouses were not visible from the road.

My last call came in just a few minutes before shift change for a frequent flyer COPD patient who had been short of breath all night. *sigh*. We were pretty close to the hospital and I only had a chance to give him a nebulizer treatment and get an IV and some labs done. Just as well because I knew from past experience that there was not much that I was going to be able to do to help him. He ended up admitted, as usual, and I was out about 45 minutes late.

Total calls for the night: 5
1 ALS transport
1 Cancelled on arrival
2 BLS downgrades
1 Cover assignment

Total milage: 126

CD for the night: "Banana Wind" by Jimmy Buffett

Back to work for the first of a string of three nights and I am very happy to be going back. While I have enjoyed parts of the last few days and have gotten a lot of work done it's time to get back.

It's supposed to rain tonight and I don't know what that will bring but I'll take whatever it is. Normally this would not be my night to work but one of the other paramedics swapped with me even though it was less than convenient for him and I needed Saturday night off. I owe him big time.

Tom Reynolds, one of my colleagues, who works in the UK for London Ambulance Service writes about the recent move for the Fire Brigades to respond to life threatening EMS calls. From the sounds of what he has written neither agency is happy with the idea except for the administrators who proposed it.

Maybe I'm pretty spoiled but I have had excellent relations with both the Fire Service and Law Enforcement based first responders in my area for the 15+ years that most of them have been providing EMS services as well. They have been involved in almost every significant intervention I have performed in my career and I have always been glad they were there.

Call me naive but I have always assumed that EMS, the Fire Service, and Law Enforcement all have the same primary charge which is to protect life. Sometimes protecting life involves pulling civilians from burning buildings or protecting the citizen from the criminal element and these are important duties, there can be no doubt. There is also no doubt that the law enforcement officer who resuscitates a cardiac arrest with an AED or the firefighter who controls severe bleeding with direct pressure a few minutes before EMS can arrive are also providing important services. Yes, this means that they sometimes end up waiting for EMS to arrive to handle the transport and provide ALS but they still are delivering a more viable patient to EMS when they arrive than if they had not been there.

I have been hearing this argument for a number of years and someone always asks "Do you want an engine company with 4 or 5 guys on it showing up when you are having a heart attack?". To be honest, if the engine company has oxygen and an AED on it and even a single person trained to use them both my answer is a wholehearted yes I do. To be honest, it wouldn't bother me a bit to have a garbage truck show up as a first responder as long as they had the right equipment and training.

Maybe I am naive, but I have always viewed things by looking at what is best for the patient and what will get them lifesaving care fastest. Beyond that all the arguments I have heard have all been posturing.

Things may be done differently on that side of the pond and I have no grasp on the legal issues involved but in my mind what is important is getting lifesaving care to the patient as fast as possible to supplement, not replace the advanced care provided by later EMS responders. If we all play on the same team everyone benefits, especially the patient.

One of the things that I have always enjoyed is walking in the rain. I'll walk in it any time as long as I don't have to ride in the back of an ambulance in it. I started following the Mattabasset Trail starting in Middlefield looking to stretch my legs, get some exercise, and, of course, find another geocache.

The beginning of the trek was pretty aggressive with a pretty steep climb up the trail to the ridge line. By the time I got to the top of that stretch of trail I was 600 feet higher than I started and my legs felt like rubber. The trail meandered along the ridge and as I walked I could imagine what the view would look like on a clear day. I'll definitely want to come back with the family sometime in the future. Preferably when the kids are older since the west side of the ridge was a pretty shear drop that went down a lot further than I was comfortable imagining.

About half way to my destination I started hearing gun fire and almost turned around. After a minute or two I realized that on the ridge like this I was about 500 feet higher than the firing range at the Connecticut Police Academy and that I was not in any danger. Even so I walked on the east side of the ridge for a while just to make myself feel better.

The cache was well hidden and almost dead on with the coordinates I had entered into my GPS. I signed in and started to head back at a slower pace than I had coming. The rain had been steadily increasing and while that wasn't bothering me there were sections of the trail that were becoming more like streams than trails and pools were developing. After finding that some of the trails were under deeper water than I had expected I started walking around the standing water instead of through it and that slowed me down.

All told it was about 2.5 miles and 700 vertical feet, a nice bit of exercise to start the day with. This afternoon will be full of housework and getting ready for my next few days at work.

fter spending so much time working on taxes I decided to take the morning off and enjoy the nice weather and get some exercise in. After I dropped my youngest off at day care I decided to try a find a couple more geocaches.

I had gone by the location of one of the caches on my way back from a call a couple of nights earlier and started there. It was a fairly steep climb down into a small valley with a spectacular waterfall at one end. It would be even better after some rain, I'm sure, but very pretty anyway. The cache was very well hidden and after finding the general area I had to look for almost half an hour before I figured out where the container was. It was a good hunt and I had a great time.

The second cache I went to search for was my first multi-stage cache. It looked like the difficulty and the terrain were perfect for my first multi. I walked through some former farm fields that had been sold to the city for use as open space and recreation areas. It felt really good to be outside in the fresh air and in the sunshine, that's something I just don't do often enough. I found the location of the first stage without any problem at all but the physical container with the coordinates for the final stage was nowhere to be found. Even after I decrypted the hint and looked at the location it specified I only found an impression in the ground where the container used to be. That was disappointing but I'll just have to come back another time after the first stage is replaced. I walked around for another hour before I headed home and felt very relaxed. there is something to be said for being out when it's light out.

I slept until 1400 and my inlaws arrived about an hour later. It was nice to see them and for some reason the strain that had been present frequently in the past was not there today and we had an enjoyable seder and dinner. The kids were all fairly well behaved and the fighting and bickering between the five of them was kept to a dull roar.

I have to say, my wife is an excellent cook and throws events like this together without any apparent effort. If it were up to me things would have been different. It would have been a disaster, that's for sure. I have nowhere close to the skill as chef and host to pull any type of gathering off. As my wife and mother will attest, meals while I was single were pretty dreadful. To this day I am forbidden to bring any Steak'ums into our house.

Busy night to start but it slowed down later. As busy as it was there was nothing that even remotely needed ALS that had been assigned to me. I had a student with me that held over from the day shift so when something that sounded interesting did come in in Medic 3's area we slid over that way and the student got in on a pretty good motorcycle wreck. The patient had a pretty nasty leg injury with some vascular compromise. Afterward the student asked how I and Medic 3 could make that determination and we both pointed out that the patient had a very large laceration on the sole of his foot that wasn't bleeding, the colour of the foot was terrible and no pulses were present. All pointing to vascular compromise resulting probably from the significant fracture and dislocations he had in his lower leg and ankle. Not as good as it could have been but better than anything else he had gotten today.

He left around 2300 and after that the night was mostly routine stuff and cover assignments. I was not complaining as I would not get a full days sleep with family coming in the early afternoon. Still I was on the road for a good portion of the night and didn't get to any of the project work that I had to do.

Total Calls for the night: 10
1 ALS assist with Medic 3
2 ALS turned over to the ALS ambulance
1 refusal
1 BLS transport
1 Unable to intercept
1 Cancelled enroute
3 Cover assignments

Total milage for the night: 126

CD for the night: "The Complex" by The Blue Man Group

I pretty much collapsed into bed this morning and was asleep before I could even get my sleep mask on. I sleep pretty heavily and didn't stir until my wife and kids got back from the movies around 1630.

The medic working days offered to stay for a while if I wanted to sleep more and come in later but even though I got out late I felt like it wouldn't be fair to him to get stuck holding over for me when I was late getting out through no fault of his. If I had been asked to hold over for him I would have probably felt like I could take advantage fo his offer but just a late call wasn't enough for me to take him up on his offer.

This morning when I left I offered to let the paramedic student that was riding today stay over into my shift for a couple of hours extra as long as his course coordinator had not problem with it. Working nights I don't get students as much as the day medics and I really do miss the opportunity to teach. I'm hoping he will stay at least for a few hours.

The night was looking like ti was going to be positively slow almost until the end. Up to that point the only patient I had transported was a very intoxicated teenager who was unresponsive. Not very challenging but it did keep me out of service for a while as the hospital of choice and the nearest hospital was not my base location. It was a nice diversion though. When I arrived I found that one of the ED nurses was a retired paramedic who I had known back in my teenage years. It was he who convinced me that I really wanted to be a paramedic and we had a great time talking about where we both were and why and all of the changes we had both had. My conversation with him had really improved my mood and I was pretty happy for the rest of the night.

Right up until 0634 when I was dispatched with a BLS ambulance to an unresponsive patient vomiting blood. Clearly I was going to get out late. I had no idea how late.

The first thing that greeted me when I arrived on the scene was the ambulance stretcher with all of their gear piled on it still outside the house. When I got inside I found the crew in the bedroom by following the whir of the suction unit. A 70ish white female was supine in bed totally flacid with copious amounts of coffee ground vomit on the bed and her. The smell was unmistakable. The crew had also brought in a long board which was actually a good thing. I always like to put handles on my patients for ease of lifting if I can. The story from the family was unclear and somewhat unhelpful. She had last been seen the day before and had been fine. Family arrived to take her to the hospital to have lab work drawn and found her in bed. I made a quick survey of the room and the only other thing that seemed relevant was the patients glucometer sitting on her nightstand with the last reading taken at around 1300 the day before. That reading had been 26 (normal is 80-120). Family confirmed her diabetic history and we headed for the ambulance.

She was an awful IV start with very small and fragile veins. Through luck, a prayer, and a fortuitus bump in the road I was able to get a very small IV started after a couple fo failed attempts. After the first attempt I had been able to get some blood to use our glucometer and I got a glucose of 8. I had never seen a reading that low before and thought that it was an error so I did it again with the same result.

I slowly pushed some dextrose into the IV and after the first 25 grams had almost an imperceptable change in her responsiveness. After the second 25 gram bolus she started to become combative but had a significantly altered mental status. For a tiny almost 70 year old she gave me and the EMT in back a run for our money to keep her form pulling her IV out. She was still vomiting copious amounts of coffee ground looking vomit and with her struggling we were having a difficult time keeping her airway clear and patent. Just before we arrived at the ED her repeat glucose level was 211 so it was pretty clear that her current mental status was not due to hypoglycemia.

In the ED she ended up getting restrained and eventually sedated. It took 2 paramedics and 3 nurses several attempts to get another IV after she pulled hers out while being restrained.

By this time I was already over an hour late getting out and I still needed to finish the paperwork and restock. The day medic had been in and was gone already on the second of his calls of the shift. My vehicle was still abandon on the scene and would need to be retreived. Normally it would just be left on scene and the day medic would have to figure out a way to get back to get it. The hospital is not big on paying extra hours for retreiving vehicles. I can understand that. It was 0830 by the time I had finished writing, restocking and generally making the equipment ready to be turned over.

The call itself had gone as well as I could have expected, all things considered but as I drove home there was a part of me that was somewhat upset about the scenario and the poor prognosis that the patient. The fact that she could have been there for over 18 hours before anyone noticed that she was not well is, as it always is, disturbing. I really hope that by the time I get to that age that I have family and friends that would notice if I was not going about my normal day to day affairs longe before that.

I punched out and was gathering my stuff together when the day medic returned. Even though I was already off the clock I offered to take a spare truck and drive him back to where my vehicle was abandon. In the long run this would be both easier and more efficient. We finally got back around 0900 and I grabbed my stuff and bolted.

At home I still couldn't head directly for bed as my wife and I needed to finish our tax paperwork. I have no love for paperwork like this and I was happy when it was finally finished.

I'm due back in at 1900 tonight and want to get some sleep.

It has been a strange kind of morning. I have spent a lot of time thinking about my career and the opportunities that are presenting themselves. I am still trying to figure out if I am hesitant to move on to another position because I really love what I am doing or because I am just plain scared of some of the challenges and changes in my day to day life that this other position would bring.

This morning I spent some time working on my resume and drafting a cover letter to accompany it for the administrative position that I am considering. It has been a very uncomfortable time trying to write this cover letter. I have never been very good at selling myself and this is no exception. I find myself doubting my professional qualifications for the first time in almost 20 years. I need to overcome the FUD factor (fear, uncertainty, doubt). I need to decide if I am ready to take on some new challenges. I wish the decision was easier and I understoof why I am afraid.

We had a meeting with my daughters doctor this afternoon. With her Aspergers Syndrome we have found that there are some dietary changes that we can make that effect her behavior. A couple of weeks ago she had some testing done on her blood, urine, and stool. Loads of fun. Today we got the results and found out that we were on the right track with the glutten free diet we had her on. She had the most significant reaction to glutten that the doctor had ever seen. In addition to glutten she had reactions to various dairy products, some fruits and vegetables. Unfortunately for her some of the stuff that the doctor would like us to restrict are the same things that she likes to eat. Things like corn and corn based cereals are gone from her diet, ketchup, vinegar, processed meats like salami. Cripes, it seems like she has nothing left but rice cakes and water.

When the doctor first told us about the test results I thought that this might not be too bad, I mean, if it will help her it's worth it. Right? I'm not having second thoughts but I can't help thinking about how difficult things are for for her and how much they will continue and become more difficult. I wish I could make things easier for her and solve all her problems but as hard as I try I just can't seem to make any progress. Sometimes I feel like we are just spinning our wheels and that she isn't and won't get any better. I love her dearly but I get so depressed thinking about what her future is going to be like.

OK, a little sleep for the weary. I headed for bed almost as soon as I got home and was asleep by about 9am. Unfortunately by 1030 I was up again and headed to the school to pick up the sick child that was awaiting me there. I am just so sick of sick kids, I really hope this is not the beginning of another set of sick days for the kids.

With my sick child in tow I had to head out in the afternoon and do the errands that were scheduled for today. Foremost among them was to pick up the defibrillator that my synagogue was purchasing. The Lifepak CrPlus is a seriously sweet piece of equipment for the non-professional rescuer. I am so happy that I was able to convince them to soend the money to get this equipment.

I'm hoping that the afternoon will be quiet enough that I can grab a quick nap on the sofa while the kids watch TV.

'm tired and I am very ready to go home and head to bed. For me the night was pretty uneventful with only two calls and two cover assignments. None of the calls were all that significant.

The significant call of the night came in just after for midnight for the medic that I releived. When I came in he was repacking and the first thing he said to me was "You night guys can keep your freakin night shifts". Well, good mornign to you too! He told me about his last call which was, on the surface, pretty straightforward, but when you stepped back was really pretty scary.

He responded for a reported MVC with the ambulance, fire rescue, and State Police already on scene. The ambulance was off the scene pretty quickly and intercepted him along the highway. Surprise! Not an MVC but rather a multitude of self-inflcited stab wounds. Oh yeah, the 6 inch knife was still plunged into his left shoulder at the base of the neck. Arm chair quarterbacking it sounds like things went pretty well. A couple of large bore lines, lots of oxygen, and restraints for the physically resisting and agressive patient. It sounded pretty hard to keep the patient under control. He was really trying to drive the knife in his neck further in by wiggling around and moving his head and shoulders. During the transport he started to develop a pneumothorax on the left side during transport but was too combative to decompress him. My colleague was saying that he fully recognized that this patient really needed to be paralyzed and intubated but without knowing where the knife blade rested with respect to the internal structures he was very hesitant to do so. I can't say that I would have been all that fast to do it either. Things could go very wrong very quickly.

While enroute the decision had been made to have the helicopter meet them at the hospital to transport to the trauma center. Since they arrived a few minutes before the helicopter they elected to head inside and between the ED staff, anesthesia, and the flight crew they were able to secure the patients airway without doing further damage.

It sounded like a very interesting and challenging call and from the armchair I thought it sounded like he had done a good job. Without the patient on the stretcher in front of me I have no firm idea how I would have handled it.

Passover began tonight at sundown. In the Jewish tradition the start of Passover is celebrated with a Seder a ceremonial dinner at which the story of the Exodus is retold. I always find passover a very inspiring time of year since the theme of the holiday is freedom and self determination. Just as the Jews escaped from slavery in ancient Egypt many people today are escaping from their own kind of slavery. What is not often remembered at during Passover is that the Jews wandered for many years in the wastelands before they found the freedom they desired.

If you read the stories of the Exodus you can see many similarities between the historical/biblical story of the Jews flight to freedom and modern people travels from bondage to freedom.

Many years ago, I am told, when Jews talked about modern people and freedom they frequently were refering to the Jews of Eastern Europe and the Soviet block who were unable to openly practice their religion. With the collapse of communism and the lifting of the "Iron Curtain" things such as religious freedom are slowly becoming a reality for them.

But worldwide there are still so many people who are not free to do as they wish without fear of persecution, imprisonment, or worse. Even in the United States, the supposed bastion of freedom in the world, we are not as free as we would like to be. The freedom to speak as we wish, act as we wish (within the limmits of the law), and travel as we wish are slowly being eroded in the name of post 9-11 patriotism.

Recently, an acquantaince of mine, a devout muslim, naturalized citizen, and U.S. military veteran was traveling from the west ocast of the U.S to the east coast. Before he boarded the plane he was stopped, questioned, searched, fingerprinted, and photographed. Was he stopped because he was of arab descent? Was he stopped because he was dressed in traditional muslim dress? Was he stopped he stopped because he was speaking arabic on his cell phone to his family? What made him seem so suspicious, so threatening that he needed to be detained and questioned before he was allowed to board a plane?

Was he assumed a threat even though he is a decorated naval veteran who was wounded both in Somalia and the first Gulf War? Was he a threat because he openly chooses to practice his religion? Was he a threat because his skin is darker than that of the rest of the people standing in line? Was he a threat because he was speaking a language that is spoken by some people who dispise the United States? I don't understand.

Now all of us, American or not, are being subjected to profiling based on religion, ethnicity, language, seemingly at random. Is this freedom? Are we free from oppression when the government is allowed in the name of "patriotism" to wairetap our phones, homes, and businesses with little if any cause. Our financial records are subject to seizure by law enforcement simply because they want them, not because they have evidence of wrongdoing. Our freedoms are slowly (and not so slowly) being eroded away in the name of patriotism.

I find this so very disturbing. What I find even more disturbing are some of the other provisions of the USA PATRIOT Act. Especially disturbing is section 805 which now makes it a crime to offer "expert advice and assistance" to any foreign organization that the Secretary of State has designated as "terrorist." The problem here is that this section is so broad that it leaves many humanitarian volunteers open to being charged under this provision. An example from my own past brings this home dramatically.

About 10 years ago I helped set up an American style ALS ambulance service in Honduras. Part of what I did was training the Honduran staff of this service is the U.S. D.O.T. standard of care. If today one of those people were found to be a member of a terrorist organization or to have committed to an act that any part of the US government considered to be a terrorist act I could be convicted and sent to prison under Section 805 of the USA PATRIOT Act for providing expert advice and assistance to a terrorist organization. Come again?!?

Disturbing. A recent paper by the Electronic Frontier Foundation gave additional examples: "A humanitarian social worker training Hamas members how to 
care for civilian children orphaned in the conflict between Israelis and Palestinians could be sent to prison. Section 805 even extends to people engaged in activities to *discourage* terrorism, such as those offering training in effective peace negotiations or how to petition the United Nations regarding human rights abuses."

This is freedom? This is what people have fought and died for for the past few centuries? Isn't this what our forefathers left the Old World to escape? Isn't this why the U.S. revolted against the colonial power of Great Britian?

Our Founding Fathers are turning over in their graves right now. I am reminded of the wise words of Benjamin Franklin "They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty or safety...". Even though the world is a much more complex place than it was in his day the simple wisdom of his statement still rings true.

I'm afraid. I am afraid that if our elected officials continue down the path they have started down in the years to come Jews will be praying at Passover for the freedom of those of us in the United States.

Not an eventful night. I did only three calls, transporting only one. Even that one was uneventful. I got quite a bit of work done and by morning, while I was tired, I was satisfied with that.

It's going to be a pretty busy day and not much time to sleep. Passover starts at sundown and we are having about 14 people over for a passover seder tonight. Lots to do but and not a lot of time to do it in.

Total calls for the night: 4
1 BLS transport
1 Cancelled upon arrival
1 BLS downgrade
1 Cover assignment

Total Milage for the night: 56

CD for the night: "Cracked Rear View" by Hootie and the Blowfish

I am looking forward to getting back to work tonight. I've been off for a week and I am ready to get back. Daylight Savings Time means that summer is on the way and we should start seeing the annual call volume increase. For the past couple of years we had not seen any fall off of our volume during the winter but this time I have noticed a definite slowdown. I want to be busy again.

I have lots to get done tonight both work related projects and some personal stuff. I need to update my resume and make a couple telephone calls. I find myself in need of the advice of some of my mentors. I haven't had to tap them for advice for a long time. We have viewed each other as equals for so many years that it feels a little strange to be here again. Either way, their advice will be invaluable. It is good to have friends and mentors that I can call on for advice and a reality check if I need it. I just wish I could still have my grandfathers advice, he didn't always understand the specifics of my situations but he had a way of breaking things down to the simplest form and making the choices much clearer. I really miss him.

Today has been a day to catch up on all the things that I didn't do while I was away. Lots of laundry, read the mail, return phone calls, give the cat a bath (don't ask, long story), groceries, run the kids around to parties and other engagements.

I'll be up late tonight so I can sleep for most of the day tomorrow in preparation to work Medic 2 tomorrow night. I'm looking forward to going back to work.

Nothing spectacularly thought provoking or significant so far nor do I expect anything.

Well I woke up this morning and found that the driving rain that had been here for the last couple of days was gone and all that was left was lots of clouds and some off and on drizzle.

Yesterday was a wash in more ways than one. I spent the morning Geocaching in the north end. It was a nice walk (even in the rain) along the waterfront to the site of the "Great Boston Molasses Tragedy" for the first cache. An hour later I knew a lot more about the strange history of this neighbourhood, but the cache eluded me. I was also totally soaked and seriously chilled. The walk back to the hotel was much less enjoyable than the walk out.

After a set of dry clothes and lunch I elected to take a dryer approach for the afternoon and I hopped on the subway (the "T" as the locals call it) and headed out to see if I could find a few more and get some pre-Passover shopping done. I found the cache I was looking for and managed to find almost all the things I needed to purchase. Still, by the time I got back to the hotel again I was soaked again.

Now into a third set of dry clothes my wife and I along with two of her partners were back off to the North End for a pretty incredible Italian meal and then to a show at a comedy club. I could have done without the comedy club since the show was about as far from funny as I have ever experienced. I kept waiting for the show to get funny and it never did.

This morning I woke up and found that the rain had subsided for the most part. I decided that today I would take my car today rather than relying on the subway. I started the day heading to East Boston to grab a couple of caches and hit them rather quickly and headed back to the city proper.

On the way back I made a unexpected side trip and stopped at the Boston Museum of Science for an unplanned visit. They had an exhibit on the life of Albert Einstein. I have always admired Einstein not only because of his intelligence but also because his views on life and the world in the larger sense. Many people suspect that Einstein suffered from Adult ADD which, as one who has ADD, makes his acheivements even more astounding. Alas, the line to get into the exhibit was very long and it was pretty clear that I would not get in for a long time. So instead I went to the planetarium show and poked around some of the other exhibits and grabbed some lunch.

After lunch it was back out into the city to find some more geocaches. I roamed through several different neighbourhoods and found 7 of the 9 caches I looked for. I was pretty happy with that.

My wifes conference was over a little before 1700 and we hit the road through the rush hour traffic to head back home. By the time we got home around 2100 I was pretty well axhausted. I somehow suspect that I will not make it much later. It was a great few days away and it just goes to prove my belief that the best vacations bring you home exhausted and relaxed.